From the Guidelines
The MRI Prostate report indicates a highly suspicious lesion with a PI-RADS 5 score, which has an approximately 80-90% likelihood of representing clinically significant prostate cancer, and requires immediate urological attention and follow-up with a targeted biopsy. This finding is located in the left transition zone (LT), mid (MID), anterior peripheral zone (APX), posterior (POST), and lateral (LAT) areas of the prostate zone (PZ). The PI-RADS v2 system is used for multiparametric magnetic resonance imaging (mpMRI) detection of prostate cancer, and it has been shown to improve the detection of prostate cancers likely to cause harm, while decreasing the detection of disease that does not lead to harm if left untreated 1, 2, 3.
The location details provided help the urologist precisely target this area during biopsy procedures, typically using fusion biopsy techniques that combine the MRI images with real-time ultrasound. According to the latest guidelines, MRI-targeted biopsy can be obtained through cognitive guidance, US/MR fusion software, or direct in-bore guidance, and it may also be possible to avoid systematic biopsies entirely by including perilesional/regional biopsies 4.
Key points to consider include:
- The PI-RADS 5 score indicates a high level of suspicion for clinically significant cancer
- The location of the lesion is in the left transition zone, mid, anterior peripheral zone, posterior, and lateral areas of the prostate zone
- Targeted biopsy is recommended, using fusion biopsy techniques that combine MRI images with real-time ultrasound
- The transperineal approach may be preferred for MRI-targeted biopsy, as it has been shown to have higher sensitivity for the detection of clinically significant prostate cancer, especially for anterior tumors 4. You should schedule an appointment with a urologist as soon as possible to discuss these findings and plan for a biopsy, as this level of suspicion warrants prompt evaluation.